The prognostic role of surgical margin width in hepatocellular carcinoma (HCC) patients undergoing hepatectomy after neoadjuvant or conversion therapy remains unclear. We retrospectively analyzed 129 HCC patients undergoing hepatectomy following neoadjuvant or conversion therapy and 720 treated with upfront surgery between 2019 and 2022. Propensity score matching (PSM) balances baseline characteristics. Disease-free survival (DFS) was evaluated by Kaplan-Meier analysis, and prognostic factors were assessed via Cox regression. Among patients receiving neoadjuvant or conversion therapy, DFS did not differ between wide (≥ 1 cm) and narrow (< 1 cm) margin groups (P = 0.572). Independent predictors of inferior DFS included CNLC-IIb stage (HR = 5.239; 95% CI:1.264–21.717), microvascular invasion (MVI; HR = 2.473; 95% CI:1.050–5.821), and postoperative interventional therapy (HR = 2.914; 95% CI:1.342–6.325), while elevated BMI was protective (HR = 0.87; 95% CI:0.763–0.993). Notably, for narrow-margin patients, DFS was significantly prolonged in the neoadjuvant or conversion cohort versus upfront surgery, both pre-PSM (P = 0.014) and post-PSM (P = 0.019). This benefit was absent in wide-margin patients. Margin width may not influence DFS in HCC patients after neoadjuvant or conversion therapy. Excessively wide margins may be unnecessary, allowing surgeons to prioritize parenchymal preservation without compromising outcomes.
Xie et al. (Sat,) studied this question.